Medicaid Fairness Act

The recipient, health care provider or both may request a hearing to appeal a denial. You may not request a hearing and reconsideration at the same time. If you request reconsideration by AFMC, you must wait until you receive notification of the outcome before you request a hearing. If reconsideration is not requested within 35 calendar days, the potential denial(s) noted in the corresponding letter(s) will become final. The Division of Medical Services will be notified of the review results. In the event that you wish to request a hearing, you may do so by writing the address below:

The provider may appear in person, through a corporate representative or, with prior notice to the department, through legal counsel. A Medicaid recipient may attend any hearing related to his or her care, but the recipient’s participation is not required.